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Acquire Student ID#

Student Type*
First Name*
Middle Name
Last Name*
Address 2
Zip Code*
Home Phone*   ( ) -
Mobile Phone*   ( ) -
Please provide either a Home or Mobile phone number
E-mail Address *
Social Security Number*
Date of Birth* //
Who is your current employer? *
If you're not sure if your employer is a Member Contractor,
choose the Employed By Member option, then enter the Company Verification Code.
If your company verification code is invalid,
then choose Employed by a Non-Member and type in the Company's name.
Please choose one of the options below
By submitting this form, I:
(1) I certify under penalty of perjury that all statements and information above are true and correct.
(2) If "YES" is selected in the "Are you currently employed by a IEC Chesapeake Member" field, I certify under penalty of perjury that the student being registered is employed by a IEC Chesapeake Member Contractor at the time registration is submitted. Any students found in violation of item (2) will be subject to expulsion without refund.